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    Surgery Department: Emergency Case Reports

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    masyfuq
    The document summarizes two emergency surgery cases from Wahidin Sudirohusodo General Hospital in Makassar on November 13th, 2019. The first case was a 13-year old male admitted for abdominal pain who was diagnosed with a periappendicular abscess based on examination and imaging findings. He underwent a laparotomy and appendectomy. The second case was a 57-year old female admitted for abdominal pain who was suspected to have a perforated stomach based on examination. During surgery a perforation in her duodenal bulb was found and repaired along with an omental flap. Both patients were treated post-operatively and their prognoses were guarded.

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    Surgery Department: Emergency Case Reports

    Uploaded by

    masyfuq
    19 views31 pages
    The document summarizes two emergency surgery cases from Wahidin Sudirohusodo General Hospital in Makassar on November 13th, 2019. The first case was a 13-year old male admitted for abdominal pain who was diagnosed with a periappendicular abscess based on examination and imaging findings. He underwent a laparotomy and appendectomy. The second case was a 57-year old female admitted for abdominal pain who was suspected to have a perforated stomach based on examination. During surgery a perforation in her duodenal bulb was found and repaired along with an omental flap. Both patients were treated post-operatively and their prognoses were guarded.

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    kasus laporan emergenci kasus di rumah sakit

    Original Title

    Emcase 13 Nov 2019

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    The document summarizes two emergency surgery cases from Wahidin Sudirohusodo General Hospital in Makassar on November 13th, 2019. The first case was a 13-year old male admitted for abdominal pain who was diagnosed with a periappendicular abscess based on examination and imaging findings. He underwent a laparotomy and appendectomy. The second case was a 57-year old female admitted for abdominal pain who was suspected to have a perforated stomach based on examination. During surgery a perforation in her duodenal bulb was found and repaired along with an omental flap. Both patients were treated post-operatively and their prognoses were guarded.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    19 views31 pages

    Surgery Department: Emergency Case Reports

    Uploaded by

    masyfuq
    The document summarizes two emergency surgery cases from Wahidin Sudirohusodo General Hospital in Makassar on November 13th, 2019. The first case was a 13-year old male admitted for abdominal pain who was diagnosed with a periappendicular abscess based on examination and imaging findings. He underwent a laparotomy and appendectomy. The second case was a 57-year old female admitted for abdominal pain who was suspected to have a perforated stomach based on examination. During surgery a perforation in her duodenal bulb was found and repaired along with an omental flap. Both patients were treated post-operatively and their prognoses were guarded.

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    EMERGENCY CASE REPORTS

    Wednesday, November 13th 2019


    SURGERY DEPARTMENT

    EMERGENCY ROOM
    Wahidin Sudirohusodo General Hospital
    Makassar
    EMERGENCY CASE REPORT
    Wednesday, November 13th 2019
    Ambulation : 2 Patient
    Hospitalized : 5 Patients
    Observation : - Patient
    Operated : 2 Patient
    Death : - Patient
    Total : 7 Patients

    Wahidin Sudirohusodo General Hospital


    Makassar
    Name : Mr. A Age : 13 yrs
    RM : 901462 DPJP : dr. TH

    Chief Complaint : Abdominal pain

    History Taking : The pain felt at lower right side of the abdomen, since
    4 days ago before being admitted to the hospital.
    Initially the pain felt in the epigastrium then moved to
    the lower right abdomen. There was history of fever,
    there was history of nausea and vomiting.
    The patient also felt a decrease in appetite. There was
    a history of watery stool. Micturition was normal
    The patient was reffered from Ibnu Sina hospital.

    There were no history of diabetes melitus or


    hypertension.
    General Status
    Moderate Illness/Well nourished/Concious

    Vital Sign
    BP : 110/70 mmHg
    Pulse : 72 x/mnt, reguler
    RR : 20x/mnt, symmetric L=R, thoracoabdominal type
    T (Ax) : 37,2°C
    Local Status
    Abdomen
    I : Flat, darm contour (-), darm steifung (-)
    A : Peristaltic was normal, metallic sound (-)
    P : Tenderness (+) at Mcburney area, palpated mass in
    the Mc. Burney area, muscle defans (-)
    P : Tymphani , liver dullness (-)
    Digital Rectal Examination

    Sphincter tone was tight


    Ampulla was collapse
    No palpable mass
    Handscoon: blood (-), feces (+), slime (-)
    Clinical Diagnosis
    Periappendicular Abcess
    Abdominal USG
    Thorax X-ray
    Laboratory Finding
     Hb : 12,9  SGPT : 60
     Hct : 39  Ur : 20
     WBC : 17.200  Cr : 0,50
     PLT : 333.000  GDS : 90
     PT : 10,9  Na : 136
     INR : 1,05  K : 4,1
     APTT : 26,5  Cl : 101
     SGOT : 47
    WORKING : Peritonitis Generalisata Et Causa
    DIAGNOSIS Appendicitis Perforasi

    MANAGEMENT : • Oxygenation
    • IVFD
    • Medicaments
    • Observation vital sign
    • Plain: Laparotomy Exploration
    Operation Procedure
    • Patient supine under general anesthesia
    • Drapping and desinfection procedure
    • Perform midline incision one finger incision is made over the
    umbilicus to two fingers above the tuberculum pubicum, deep and
    sharp blunt to the peritoneum. Open the peritoneum
    • Exploration of the abdominal cavity, looking pus as much as 100 cc.
    Pus drainage, then washed with normal saline until clean
    • Further exploration, looks appendix subheptal location, sticky with
    surrounding tissue, looks hyperemic, inflammation with perforation in
    the distal part
    • Adhesiolysis was done then continued with the appendectomy
    procedure with double ligation
    • Controll bleeding, irrigate wound with normal saline
    • Applied 1 drain with tip on retrovesica
    • Suture wound layered by layered
    • Operation finished
    Operation Documentation
    Operation Documentation
    POST OP : Peritonitis Generalisata Et Causa
    DIAGNOSIS Appendicitis Perforasi

    PROGNOSIS  Dubia

    FOLLOW UP  Sign of acute abdomen


     Vital signs
     Drain production
    Name : Mrs. S Age : 57 yrs
    RM : 892848 DPJP : dr. SM

    Chief Complaint : Abdominal pain

    History Taking : Pain felt throughout the stomach, since two days ago,
    the pain felt when her stomach is pressed and
    worsened since one day ago. The patient also
    complained of nausea and vomiting three times one
    day ago. there is no history of pain medication or
    herbal medicine comsumption. no previous history of
    trauma.

    There were no history of diabetes melitus or


    hypertension.
    General Status
    Moderate Illness/Well nourished/Concious

    Vital Sign
    BP : 80/60 mmHg
    Pulse : 102 x/mnt, reguler
    RR : 22x/mnt, symmetric L=R, thoracoabdominal type
    T (Ax) : 36,6°C
    Local Status
    Abdomen
    I : Flat, darm contour (-), darm steifung (-)
    A : Peristaltic was normal, metallic sound (-)
    P : Tenderness (+), palpable mass in the Mc. Burney
    area, muscle defans (-)
    P : Tymphani, liver dulllness (-)
    Digital Rectal Examination

    Sphincter tone was tight


    Ampulla was collapse
    No palpable mass
    Handscoon: blood (-), feces (+), slime (-)
    Clinical Diagnosis
    Peritonitis Et Causa Suspect Perforasi Gaster
    BNO 3 POSITION

    Erect
    Supine
    LLD
    Foto Thorax
    Laboratory Finding
     Hb : 9,8  Ur : 65
     Hct : 29  Cr : 1,32
     WBC : 7.000  GDS : 159
     PLT : 625.000  Na : 124
     PT : 11.4  K : 5,7
     INR : 1.10  Cl : 97
     APTT : 22.3  Alb : 3.3
     SGOT : 33
     SGPT : 16
    WORKING : Peritonitis Generalisata Et Causa Suspect
    DIAGNOSIS Perforasi Gaster

    MANAGEMENT : • Oxygenation
    • IVFD
    • Medicaments
    • Observation vital sign
    • Plain: Laparotomy Exploration
    Operation Documentation
    Operation Documentation
    Operation Procedure
    • The patient lied in supine position under general aneshesia
    • Disinfection and drapping procedure were performed on abdominal surface
    • Incision was performed from midline 2 finger processus xyphoideus to mid
    umbilicus and symphysis pubic, the incision was deepened sharply until
    peritoneum was visualized
    • Opened peritoneum, there was yellowish fluid much ±400 cc. Clean the
    liquid with suction.
    • Identification was obtained perforation in duodenal bulbus 0.5x0.5 cm and
    refreshing 0.5 cm to obtain healthy tissue and primary suturing was
    performed. Tissue was examined in Pathology Anatomy
    • Followed by duodenal repair and omental flap
    • Re-identification of the duodenum and hollow viscus organs was not found
    other abnormalities
    • Controlled bleeding and rinse abdominal cavity with warm normal saline until
    clean
    • Tide a drain in sulcus hepatoduodenal and cavum douglasi
    • Closed the operation wound, sewing wound layer by layer
    • Operation finished
    POST OP : Peritonitis Generalisata Et Causa
    DIAGNOSIS Perforasi Bulbus Duodenal

    PROGNOSIS  Dubia

    FOLLOW UP  Sign of acute abdomen


     Vital signs
     Drain production
    TERIMA KASIH . . .

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